Helena M. Pakter

Optical Coherence Tomography Measurement of Macular and Nerve Fiber Layer Thickness in Normal and Glaucomatous Human Eyes

PURPOSE To evaluate the hypothesis that macular thickness correlates with the diagnosis of glaucoma. DESIGN Cross-sectional study. PARTICIPANTS We studied 367 subjects (534 eyes), including 166 eyes of 109 normal subjects, 83 eyes of 58 glaucoma suspects, 196 eyes of 132 early glaucoma patients, and 89 eyes of 68 advanced glaucoma patients. METHODS We used optical coherence tomography (OCT) to measure macular and nerve fiber layer (NFL) thickness and to analyze their correlation with each other and with glaucoma status. We used both the commercial and prototype OCT units and evaluated correspondence between measurements performed on the same eyes on the same days. MAIN OUTCOME MEASURE Macular and NFL thickness as measured by OCT. RESULTS All NFL parameters both in prototype and commercial OCT units were statistically significantly different comparing normal subjects and either early or advanced glaucoma (P < 0.001). Inner ring, outer ring, and mean macular thickness both in prototype and commercial OCT devices were found to be significantly different between normal subjects and advanced glaucomatous eyes (P < 0.001). The outer ring was the only macular parameter that could significantly differentiate between normal and early glaucoma with either the prototype or commercial OCT unit (P = 0.003, P = 0.008, respectively). The area under the receiver operator characteristic (AROC) curves comparing mean NFL thickness between normal and advanced glaucomatous eyes was 1.00 for both the prototype and commercial OCT devices for eyes scanned on both machines on the same day. The AROC comparing mean macular thickness in normal and advanced glaucomatous eyes scanned on both machines on the same day was 0.88 for the prototype OCT device and 0.80 for the commercial OCT. CONCLUSIONS Both macular and NFL thickness as measured by OCT showed statistically significant correlations with glaucoma, although NFL thickness showed a stronger association than macular thickness. There was good correspondence between findings using both the prototype and commercial OCT units. Macular and NFL thickness measurements made with OCT may have usefulness in the clinical assessment of glaucoma.

Persistent hypotony after primary trabeculectomy with mitomycin C

Objetivo: Descrever os achados clinicos e as modalidades de tratamento da hipotonia persistente apos trabeculectomia primaria com mitomicina C. Metodo: Foram retrospectivamente analisados 9 olhos com hipotonia persistente, a qual foi definida como pressao intra-ocular igual ou menor que 5 mmHg por mais que 2 meses. Resultado: Tempo medio de duracao da hipotonia foi de 7.4 meses, desvio padrao ± 6.7 meses. Complicacoes associadas a hipotonia incluiram descolamento de coroide (2 olhos), maculopatia (5 olhos). Todos os pacientes que desen-volveram maculopatia eram relativamente novos (idade media de 37 anos, desvio padrao ±16). Tratamentos incluiram lente de contato, injecao autologa de sangue, facoemulsificacao, re-sutura do retalho escleral, e concha de Simmons. Apos tratamento, houve melhora da pressao intra-ocular (PIO) em todos os pacientes (media final da PIO= 11.1 mmHg, desvio padrao ±3.51, media da PIO no 1° dia = 3 mmHg, desvio padrao ±1.7). Na ultima visita, a acuidade visual (AV) permaneceu constante em 3 olhos, piorou em 2 olhos ( piora de 2 linhas de Snellen). Houve melhora da AV em 4 olhos (1 a 4 linhas de Snellen). Foi realizada facoemulsificacao em 3 olhos dentre aqueles em que houve melhora da acuidade visual. Conclusao: Hipotonia pos-trabeculectomia com mitomicina C pode ser reversivel com possivel melhora da visao.

Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature

The diagnosis of angle-closure glaucoma secondary to iridociliary cysts is challenging and lacks compiled literature support. We present a rare case of bilateral angle-closure glaucoma associated with pseudoplateau iris due to multiple ciliary cysts and conducted a systematic review of the literature to find similar case reports published between November 2006 and November 2016. Only 19 case reports present treatment modalities, and most cases required more than one therapeutic approach for controlling the intraocular pressure. Pseudoplateau iris attributed to iridociliary cysts should be considered in the differential diagnosis of patients with narrow angles, particularly those with ocular hypertension and glaucoma, in which management is complex. In addition to gonioscopy, ultrasound biomicroscopy is considered the conclusive method for accurate diagnosis.